摘要
目的应用超声心动图对比研究二叶式与三叶式主动脉瓣重度狭窄患者经导管主动脉瓣置换术后左室逆重构。方法回顾性分析2013年3月至2018年12月在浙江大学医学院附属第二医院行经导管主动脉瓣置换术的主动脉瓣重度狭窄患者276例,根据术前主动脉CT图像分为三叶组(161例)和二叶组(115例)。比较两组术前、术后1周、术后1个月、术后1年超声心动图指标主动脉瓣口峰值流速(Vmax)、平均跨瓣压差(PGmean)、有效瓣口面积(EOA)、舒张期室间隔厚度(IVSd)、舒张期左室后壁厚度(LVPWd)、舒张末期左室内径(LVEDd)、左室心肌质量指数(LVMI)、左室心肌质量指数变化分数(ΔLVMI%)、左室射血分数(LVEF)的差异。结果①与术前相比,TAVR术后1周、1个月、1年三叶组和二叶组Vmax、PGmean下降,EOA增加(均P<0.05);术后1年三叶组与二叶组Vmax、PGmean、EOA、中度及以上瓣周漏、中度及以上人工瓣膜功能不匹配差异无统计学意义(均P>0.05)。②与术前相比,两组术后1个月、1年LVEDd、IVSd、LVPWd下降,术后1周、1个月、1年LVMI下降,LVEF升高,差异有统计学意义(均P<0.05)。③二叶组术前LVMI较三叶组低,但两组间术后1周、1个月、1年ΔLVMI%差异无统计学意义(均P>0.05);两组术后LVMI下降趋势差异无统计学意义(P>0.05)。结论主动脉瓣重度狭窄患者经导管主动脉瓣置换术后早期发生左室逆重构并持续到术后1年,二叶式与三叶式患者以LVMI为代表的左室逆重构趋势相似,患者同样获益。
Objective To compare the left ventricular(LV)reverse remodeling after transcatheter aortic valve replacement(TAVR)between patients with bicuspid aortic valve(BAV)stenosis and tricuspid aortic valve(TAV)stenosis.Methods The data of patients who underwent TAVR procedure from March 2013 to December 2018 in the Second Affiliated Hospital of Zhejiang University were retrospectively reviewed.The patients were divided into BAV group and TAV group according to cardiac computed tomography.Echocardiographic parameters,including aortic valve peak velocity(Vmax),mean gradient(PGmean),effective orifice area(EOA),interventricular septum diastolic thickness(IVSd),left ventricular posterior wall diastolic thickness(LVPWd),left ventricular end diastolic diameter(LVEDd),LV mass index(LVMI),ΔLVMI%,left ventricular ejection fraction(LVEF)of the two groups at baseline,1 week,1 month and 1 year post TAVR procedure were obtained and compared.Results①Compared with preoperative measurements,both groups showed decreases in Vmax,PGmean and increase in EOA at 1 week,1 month,1 year follow-ups(all P<0.05).No significant differences were found in Vmax,PGmean,EOA,moderate/sever perivalvular leakage(PVL),moderate/sever prosthetic-patient mismatch(PPM)between BAV group and TAV group at 1 year.②Both groups showed decreases in IVSd,LVPWd,LVEDd at 1 month,1 year post TAVR compared with those before the procedure(all P<0.05),as well as increases in LVEF at 1 week,1 month,1 year(all P<0.05).Downward trends of LVMI were detected in both groups within 1 year follow-up(P<0.05).③Compared to TAV group,BAV group showed smaller baseline LVMI(P<0.05),while there were no significant differences inΔLVMI%post TAVR for all follow-up times of the two groups(all P>0.05).Repeated measures analysis of variance also showed no significant differences in downward trend of LVMI between the two groups after TAVR within 1 year(P>0.05).Conclusions Left ventricular reverse remodeling can be detected in both BAV and TAV patients after TAVR,which starts from 1 week and
作者
黄朝旭
蒲朝霞
张雨薇
周丽明
夏向阳
刘先宝
李晶
鲍晓峰
王建安
Huang Zhaoxu;Pu Zhaoxia;Zhang Yuwei;Zhou Liming;Xia Xiangyang;Liu Xianbao;Li Jing;Bao Xiaofeng;Wang Jian′an(Department of Cardiology,the Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2021年第7期592-597,共6页
Chinese Journal of Ultrasonography
基金
浙江省医药卫生科技计划项目(2018KY409)。
关键词
超声心动描记术
经导管主动脉瓣置换术
二叶式主动脉瓣
主动脉瓣狭窄
左室重构
Echocardiography
Transcatheter aortic valve replacement
Bicuspid aortic valve
Aortic valve stenosis
Left ventricular remodeling
